PROJECT SUMMARY Owing to the heightened risk of medication errors during patient care transitions, the ?meaningful use? of the EHR Medication Reconciliation functionality, has potential to significantly improve quality & patient safety, and reduce healthcare costs. Despite the federal policy impetus towards EHR Medication Reconciliation however, hospital adherence has lagged for one chief reason?low physician engagement?which in part, stems from lack of professional consensus about which physician is responsible for managing a patient's medication list and the value of medication reconciliation as a clinical tool for improving quality of care. GR Health has recently launched certified EHR technology throughout its health system. Like many hospitals, a key challenge faced by GR Health is that physicians who did not place the original order for a patient's medication, are resistant to completing EHR Medication Reconciliation at discharge, leading to frustrated patients with incomplete medication lists and higher-than-expected medication error rates. This pilot/feasibility project seeks to implement a Social Knowledge Networking (SKN) system to enable GR Health to progress from ?limited use? of EHR Medication Reconciliation technology, to ?meaningful use.? Step 1 (Development Phase) will be to enhance an existing SKN system (Microsoft-Yammer's) capability to promote EHR medication reconciliation; and integrate the tool into the EHR workflow at GR Health. Step 2 (Pilot Phase) will be to conduct a pilot/feasibility test of the SKN system in the outpatient & inpatient settings at GR Health. Specific aims are to examine: 1) user-engagement in the SKN system through SKN user surveys & SKN usage analytics; and 2) preliminary associations between ?SKN use? and ?EHR meaningful use.? The rationale is that an SKN system would bring together a diverse group of practitioners (physicians, nurses, pharmacists, IT specialists, and administrators), to facilitate the exchange of tacit knowledge (practice- based knowledge) on the problem of interest. Tacit knowledge exchange in turn, is expected to increase practitioners' engagement in solving the problem, promote learning, and enable practice change (i.e., EHR meaningful use). The pilot study would include 6 SKN Moderators (senior administrators & MD champions) and 60 SKN Users (practitioners) from the outpatient & inpatient medicine service. The hypothesis is that proactive, periodic ?top-down? efforts of SKN Moderators to promote EHR Medication Reconciliation would synergize with ?bottom-up? exchange of tacit knowledgeby SKN Users, to enable engagement, learning, and meaningful use. The project is highly responsive to the FOA, since it seeks to test a strategy for health IT use, implementation, and design, which in turn is aligned with three of AHRQ's five health IT research priorities. If the hypothesis holds, federal EHR vendors could be encouraged to incorporate SKN features into EHR systems. The study will utilize a range of quantitative, qualitative, and social network analytic techniques to examine SKN user engagement, SKN usability, SKN usage analytics, and EHR meaningful use.